Transcription of Form 30482 - Request for IRA/Roth ANNUITY Transfer or ...
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Y (10/19)304821 Owner NameAmount to be moved:Plan Type:Outgoing ANNUITY Tax- qualified Transfer , Exchange, Conversion or Direct Rollover from RiverSource life Insurance CompanyTraditional IRA (including Rollover and SEP)Roth Contributory IRAS imple IRATax-Sheltered ANNUITY (TSA)Roth Conversion IRAI nherited (Beneficial) IRA Full (100%)Specific Amount $Withdraw total free amount without incurring surrender chargesWithdraw 10% free amountProduct TypeProduct NameCompany NameAccount You Are Moving Assets To continued on next NameFixed AnnuityVariable AnnuityMarket Value AnnuityFixed Index AnnuityImmediate AnnuityMutual Fund CDBrokerageOtherAdvisor/Agent NameRiverSource life Insurance Company 70100 Ameriprise Financial Center Minneapolis, MN 55474 RiverSource life Account You Are Moving Assets FromPart 1 Account You Are Moving Assets ToPart 2 2008 - 2019 RiverSource life Insurance Company.
RiverSource Life form 33442 for Traditional IRA annuities or form 200702 for 403(b) annuities or by calling 1.800.862.7919. To transfer or rollover a 401(a) plan, use Form 4292. To exchange non-qualified contracts, use Form 30481. Page 1 of 5 i! Sign on Page(s) 4, 5 Policy/Contract Number Account Number For RiverSource® annuities held inside a
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